Discussion Guide for the Amorim Article

• DOI: 10.4037/ajcc2024993
• Publication Date: 2024-03-01T03:44:00Z
• Authors: Grant A. Pignatiello
• Keywords: Oxygen therapy

Oxygen, a mainstay treatment for hypoxemia, is one of the most frequently used therapies hospitalized patients. Overuse oxygen may contribute to hyperoxemia, which clinicians commonly disregard. However, hyperoxemia can cause pulmonary toxicity, disrupt antioxidant function, and strain cardiovascular system. Similarly, excessive administration (EAO) impair mucociliary transport if not adequately humidified heated, high fractions inspired absorption atelectasis, tracheobronchitis, immunosuppression. Although linked poor clinical outcomes in specific situations (eg, septic shock acute myocardial infarction), evidence conflicting among critically ill Some studies systematic reviews report an association between mortality, whereas others, including randomized trials, show no significant differences outcomes, leading uncertainty about overall impact EAO on patient survival. Therefore, authors present study sought determine prevalence therapy–induced its with hospital mortality nonsurgical In addition, examined factors related upon admission, need mechanical ventilation, vasopressors, renal replacement therapy during patient's stay intensive care unit (ICU).This prospective cohort included all consecutive admissions nonsurgical, adults who received admission ICU (N = 3088). Within first hour 38% (n 1174) patients were hyperoxemic (Pao2 > 120 mm Hg). multivariate analyses, higher rates associated increasing age presence chronic kidney disease, while organ dysfunction, late-night admissions, diagnoses (ie, renal/metabolic, digestive, soft tissue/skin/orthopedic) lower rates. Compared normoxemic 60–120 Hg) hypoxemic <60 patients, required longer hospital. Furthermore, odds dying increased by 32% was stay. therapy. Given potential risks conclude that should remain vigilant monitoring levels critical illness.Dr Fábio Ferreira Amorim, corresponding author this article, has observed concerning trend toward use As he highlights, "oxygen stands as cornerstone management respiratory failure, given pivotal role addressing primary contributor condition." Despite significance, Dr Amorim notes often overused owing ready availability fear effects hypoxemia. inadequate peripheral saturation many monitors compounds risk, insufficient alarms detecting hyperoxemia. Recognizing articulates motivation study: "We designed evaluate induced at correlation mortality."According main difficulty encountered execution amid COVID-19 pandemic. The pandemic, described authors, brought overwhelming demands Brazil's health system, overloaded ICUs, specialized staff, shortages essential equipment resources. These challenges created unique scenario where immediate attention resources demanded care, team simultaneously dedicated advancing research could shed light rational oxygen.Despite challenges, says successful largely because "the group history teamwork previous projects patients." diverse professionals, professors, students from 4 universities, brings varied expertise enrich process. gradual formation highlights importance sustained collaboration evolution collective understanding. Amorin emphasizes, "This collaborative spirit will yield further insights advancements they continue their projects."Dr envisions future trials different Pao2 cutoffs, providing more precise understanding relationship hyperoxe-mia outcomes. exploration targets step refining approach enhancing ICU. He concludes, expect forge path personalized evidence-based approaches optimize foster culture continuous improvement medicine."For now, emphasizes balanced when using bedside: "The risk lies narrow safety margin separating effective toxic doses." stress shedding prevalent phenomenon time independently mortality. Their aims challenge perception entirely risk-free informed tempered therapy, ultimately optimizing resource ICU.This feature briefly describes personal journey background story EBR article's lead investigators, discussing circumstances led them undertake line inquiry represented article featured issue.Dr Amorim's 29-year career, Medical School University Brasília (UnB) professorship Health Sciences (ESCS) Brasília, been marked commitment research. His passion ignited medical residency Federal Sao Paulo, focusing physiology ventilation. academic trajectory, master's doctoral São shaped orientation curiosity therapy's adverse effects. Balancing roles manager, coordinator graduate program sciences ESCS, professor UnB, bridges academia practice, enriching both his students.